[Congressional Record Volume 165, Number 23 (Wednesday, February 6, 2019)]
[House]
[Pages H1386-H1388]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           DEMOGRAPHIC BUBBLE

  The SPEAKER pro tempore (Mr. Johnson). Under the Speaker's announced 
policy of January 3, 2019, the Chair recognizes the gentleman from 
Arizona (Mr. Schweikert) for 30 minutes.
  Mr. SCHWEIKERT. Mr. Speaker, what we are doing today is sort of a 
continuation of the theme that since the beginning of this Congress we 
have been walking through. So let's put this sort of in context.
  This is probably our fourth or fifth time to come to the floor and do 
part of this theme. The first time we did this we took almost an hour 
and we actually sort of walked through what is happening in our 
society, when you actually do the math of the massive unfunded 
liabilities in Medicare; the issues with the fact that in 9 years, 50 
percent of the noninterest spending of this government in 9 years will 
be to those 65 and over.
  So it is important to understand what is happening to us 
demographically. Much of that difficulty that is coming toward us is 
about healthcare costs.
  One of my passions has been trying to get an understanding of this. 
There are a number of things we can do to actually deal with the fact 
that we are getting older as a society. We are seeing what is happening 
on our birth rates. The fact of the matter is, those of us who are baby 
boomers--there are 74 million of us--and in 9 years, all of the baby 
boomers will be functionally 65 and older.
  It is a demographic bubble moving through our society, and there are 
benefits that we as a society have been promised. So what do you do? 
How do you make sure you have a vibrant enough economy to keep our 
promises? How do you make sure we have a vibrant enough economy not to 
crush the young in their opportunities?
  We have been laying out five little legs. We will call them our 
proposals, everything from an immigration system that is talent based 
so you maximize economic vitality; policies, such as tax, regulatory, 
trade, that maximize economic growth; policies that are all up and 
down, whether it be our programs within the social safety net, or just 
incentives within Social Security, and Medicare; other programs to stay 
in the workforce or enter the workforce because labor force 
participation is crucial.
  We had a good number last month where we broke over 63 percent labor 
force participation. I know this sounds a little geeky, but it is 
crucial.
  The fifth one--and we will come back to the fourth--the fifth one is 
looking at our retirement entitlements and how we design them to 
incentivize everything from being a good consumer to staying in the 
labor market longer. But the fourth one that we keep talking about over 
and over and over again is technology.
  Once again, I put up this slide right here just to understand the 
scale. In a decade, you and your partner, if you have jobs, there will 
be two people working for every one person in retirement in 10 years: 
two workers, one retiree. And understand Medicare and Social Security 
are functioning right now as pay-as-you-go programs because we are 
using today's income to pay today's retirees.
  The next slide is just to emphasize the scale of the unfunded 
liability. When you look at this slide, you will see up on the top that 
this is the 30-year projection. It is not adjusted for inflation. So if 
you want to adjust it for inflation, you can remove a third of the 
value. But, functionally, over the next 30 years, you have an $84 
trillion unfunded liability when you add in the cost of the programs 
and the interest related, $84 trillion over the next 30 years.
  But if you take a really close look, almost all of that comes from 
Social Security and Medicare. The rest of the budget has about a $16 
trillion on the positive side, so you have got an $84 trillion 
shortfall. So what do you do as far as solutions?

[[Page H1387]]

  Well, we are going to show some slides of some creative ideas. 
Remember, we are working on that. We have five piers. Right now we are 
going to talk about our technology pier. Just, once again, to sort of 
get your head around these numbers, from 2008 to 2028, the calculation 
is 91 percent of the increased spending of this Federal Government will 
be interest, Social Security, and healthcare benefits.
  Your government is functionally an insurance company with an Army. So 
how do you have a revolution in healthcare costs? We have lots of 
proposals around here, and if you listen to them--and we have got to be 
brutally honest--think about the ACA, many know it as ObamaCare, or 
some of our alternatives; we are often having a debate of who gets to 
pay. Those don't have a revolutionary--they don't have a disruptive 
nature in the cost of healthcare services. We are just moving around 
saying: we want more government subsidies. No, we want more 
nongovernmental private-sector competition, but we are often moving 
around who gets to pay.
  Our argument is we are in the middle of a technology revolution. How 
many of you have a watch that helps you manage your blood pressure? How 
many of you have seen the patch that helps you manage your blood 
oxygen? There are a number of these sorts of things--we call them 
digiceuticals--that are coming onto the market. We as a body need to 
drag technology into this debate so technology brings us a disruption 
in the cost.
  I say this over and over and over, but it is a good visual. When was 
the last time you went to Blockbuster video? Didn't it feel like almost 
overnight from going down and getting the little silver disk and 
getting a movie recommendation to now you go home and hit a button? We 
are living in a society that is having an amazing technological 
revolution.
  What happens when this supercomputer in your pocket is functionally 
your primary-care physician? It turns out that that technology is here 
today, but we as a body need to talk more about who gets to pay and 
more about lowering the price of healthcare.
  I will argue that the elegance of dragging this technology, removing 
the barriers, removing our inequities in the compensation for using 
this healthcare IT is we will be healthier. We will deal with our 
issues much faster, particularly for those of us who have very busy 
lives, instead of waiting for that appointment.
  So I want to just show some of the revolution that is already out 
there. These things are already out there in our society.
  This next slide shows a handheld ultrasound. It is basically the size 
of your phone. You plug it into your Bluetooth, or you plug it into 
whatever, iPhone--at least I think this one is an iPhone in this 
picture--and it is a handheld ultrasound.
  What happened to the days when you used to have to go to a medical 
clinic that had the specialty equipment? You would sit there and find 
out that you had a bone chip in your heel. Now, you are at your office, 
your nurse's office, your company's office. You can actually buy this 
as an individual. You can actually see, and we are reading articles 
that are saying very soon you won't actually look at the picture. You 
will use this handheld ultrasound and the algorithm will actually tell 
you what it is seeing. This is a revolution.
  Right now, I think you can buy one of these on Amazon for under 
$2,000. Conceptually something that used to be a large piece of 
equipment is in the palm of your hand. That is a revolution.
  We are about to have a series of discussions about drug pricing. Drug 
pricing is a huge component of what we do to have a revolution in the 
cost of healthcare.
  Here is a quick thought experiment. What if I came to you and said: 
50 percent of the pharmaceutical prescriptions that will be written 
this year will not be properly used or used at all. So just as a 
thought experiment, half the pharmaceutical prescriptions written this 
year just won't be used at all, or will be misused.
  Well, right there--it is absurd to say if we would fix this problem 
we would have a 50 percent reduction in the need to pay for 
pharmaceuticals, but it could be a huge impact. This has less to do 
with fighting over the formularies, the mechanisms over here. Will we 
have enough money for healthcare research? This is just about proper 
utilization.
  So what would happen if I would come to you right now and say: I have 
a relative who has some dementia issues or did you take your 
hypertension medicine this morning? Turns out, we can actually put on a 
bottle cap that actually would talk to your phone saying: Hey, you did 
not take your pill today. Hey, you did not take your pill in the time 
prescribed that you are supposed to take it.
  Something like this, as simple as this, is a technology solution to 
an issue where we know we have lots and lots of seniors that don't take 
their medicines on time or in the proper fashion.
  We even have more complicated ones that are in the same vein. What if 
you are someone who has multiple pills that you take? This one was 
particularly designed for seniors with some memory issues combined.
  This is a dispensary that was just shown at the Consumer Electronics 
Show in Las Vegas 3 weeks ago. At a certain time, it notifies you and 
drops the prescribed combination of pills into a little cup for you. It 
is a technology solution for drug utilization where we know that 50 
percent of pharmaceuticals are not being properly used.
  Mr. Speaker, I beg of us as a body, we need to get out of our 
rhetoric sounding like it is the late 1990s. There is a technology 
revolution around us. Let's drag that creative thought, creative design 
into our debate and say, this is more than the continuing debate of who 
pays, who doesn't pay. It is: we need a revolution in how we stay 
healthy.
  Is this Republican or Democrat? I am making the argument it is 
technology. Now, as we joke in our office, eventually, we will figure 
out that one party will take a side so we can fuss at each other. But 
at least right now, the discussion of dragging technology into our own 
personal healthcare is not partisan. It is a solution. Let's go on to 
the next slide.

  About 2 years ago I had a situation where I was cooking. It was a 
Sunday evening. I love to cook, and I almost chopped off my pinky. So I 
am at the emergency room in Scottsdale, Arizona, and I am bleeding like 
crazy.
  The wonderful person who is on the intake side in the emergency room, 
as I am bleeding down my arm, is saying: David, do we have your medical 
records? Are you allergic to anything?
  And I am going: I am bleeding. Well, the absurdity is my medical 
records were in the office that was closed because it was a Sunday 
evening. I should have my medical records with me and you should have 
your medical records with you. It is not that hard. It turns out others 
agree. This technology is out there.
  Now, I had the blessing of being the co-chair of the Congressional 
Blockchain Caucus. I actually believe there is a really elegant way of 
using an encrypted, what we call, blockchain, a distributive ledger, 
with levels of permission. So it is more than just my medical records, 
because, as we are going to show in a couple more slides, this is 
actually just the beginning.
  If I can carry my medical records with me on this, why can't I have 
that wearable that helps me manage my diabetes, also doing 24 hours, 7 
days a week data; the thing that actually helps me deal with my heart 
arrhythmia, 7 days a week, 24 hours every day. That type of algorithmic 
data is also attached to my medical files; instead of thinking that my 
medical professional is going to find out I have an issue in that 15 
minutes I am in their office.

                              {time}  1545

  This is more than a medical record concept. If I am able to have 
digiceuticals--wearables--that will help me manage my healthcare and 
help me manage my chronic condition, will I be healthier?
  Mr. Speaker, it is like the contact lens that actually helps manage 
your blood glucose talking to your pump, so you don't crash if you are 
diabetic, it helps maintain you. You already see some of that 
technology on a number of people's shoulders today where it is actually 
Bluetoothing into the pump.
  The revolution is already around us using these technologies. We, as 
a

[[Page H1388]]

body, need to have a very honest conversation of how do we remove 
barriers--and we will need our friends at the State and local level to 
also remove some of their regulatory barriers--to allow the adoption of 
these types of technologies.
  The thought experiment goes a little further. In the Scottsdale 
area--I think we now have five or six, maybe seven of them up--there 
are functionally autonomous healthcare clinics. It is a crazy thought. 
You walk in, you sign up on an iPad, and you take a picture of your 
insurance card. You go into a booth, and the avatar on the screen talks 
to you and says: Can you shine this in your nose? Can you turn it 
right, turn it left? It will show you.
  This avatar bends the device, and then says, put it in your ear, turn 
it, and down your throat, turn it, turn it. It is autonomous. Think 
about the cost savings.
  The algorithm does a calculation and says: we are actually 
calculating you have the flu.
  It turns out that algorithm is remarkably accurate.
  Now, in today's world, at the very end of the consult, a doctor comes 
on to the screen and talks to you. A doctor can choose to hit the 
button and accept that algorithm.
  But, conceptually, think about that. What if that type of technology 
wasn't just sitting in an autonomous healthcare clinic, but was at your 
school nurses' office, your office?
  How about if it got small enough, compact enough, and inexpensive 
enough so it was at your home?
  How many of us have had the occasion where we have the cold or the 
flu, we suffer with it for a couple days, and then we start saying: Can 
I go to the urgent care center? Maybe I can get an appointment with my 
doctor.
  By the time you show up at your doctor's appointment, Mr. Speaker, 
you are actually already on the mend.
  I have a picture on my phone of something that looks like a large 
kazoo, and here is the final part. You blow into this, Mr. Speaker, and 
it is able to tell you if you have a viral infection--the flu--or a 
bacterial infection like a cold.
  What would happen if that large kazoo you could have sitting at home, 
you blow into it, it says that you have the flu, we are ordering your 
antivirals, and they are going to be delivered--let's say by a drone or 
an autonomous vehicle, if we are going to be really techno-utopian--and 
it is delivered to your home a couple of hours later.
  How much healthier did our society get? The fact you didn't go to 
work and infect everyone; that you were able to deal with this almost 
immediately; that the time between actually getting your pharmaceutical 
to actually manage this infection and the moment you were feeling sick 
it is now hours.
  How much cost did you just save out of the medical system?
  So I need us all to be creative here and think this issue through. If 
50 percent--actually more than 50 percent of our healthcare cost is 5 
percent of our brothers and sisters with chronic conditions; we already 
know these types of technologies are helping us manage individuals' 
needs and issues who have chronic conditions.
  We saw the pill bottles to make sure that--is there a way that the 50 
percent of pharmaceuticals that are not being properly used or used at 
all are being properly managed? Our ability to manage our data is going 
to be coming from all these healthcare devices.
  So my thesis is very, very simple. As we have the arguments about 
drug prices and as we have the arguments about healthcare costs, we 
need to have the discussion of it is time for a technology revolution, 
and we need to drag that technology solution into the debate in how we 
regulate, how we incentivize, and how we compensate.
  Because, Mr. Speaker, I will make you the argument: this is the 
moment that--if you remember, the first couple slides were the 
healthcare costs that we have committed to as a society that 
functionally consume almost every incremental dollar of our future. 
What would our future look like if we were able to bend that cost curve 
because we actually found and embraced the technology disruption that 
is on our doorstep?
  Wouldn't this be a much more elegant debate and a much more 
optimistic conversation?
  That is what I have for today. But we are going to do the next phase 
of this next week and the week after that to sort of walk through these 
pillars of, there is a path where we can make this work.
  Mr. Speaker, I yield back the balance of my time.

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